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HNO 30. Mai 2016

Pre-therapeutic fibrinogen levels are of prognostic significance in locally advanced head and neck cancer

Objectives: The objective of this retrospective study was to clarify the potential prognostic significance of pre-therapeutic fibrinogen levels in head and neck squamous cell carcinoma (HNSCC) patients treated with curative intent by primary radiotherapy (RT) or with postoperative radiotherapy (PORT).

Patients and methods: We retrospectively analyzed data from 347 patients with histologically confirmed locally advanced HNSCC. Analysis was conducted separately for the patient collective treated with PORT (N = 141; 85.1 % AJCC stage III/IV) and for patients treated with primary RT (N = 206; 97.1 % AJCC stage III/IV). Kaplan Meier analyses as well as univariate and multivariate survival analyses were performed to identify factors associated with overall survival (OS).

Results: The most relevant observation was that plasma fibrinogen levels were significantly associated with a reduction of overall survival rates. In the low-fibrinogen (below 411 mg/dL) postoperatively irradiated group, OS rates at 2 and 3 years were 86 and 83 %, and in the high-fibrinogen group 66 and 51 %, respectively. In the RT group with low fibrinogen levels, OS rates after 2 and 3 years were 74 and 53 %, and in the high-fibrinogen group 40 and 22 %, respectively. In multivariate analysis, elevated fibrinogen concentrations were associated with inferior OS in both the postoperatively (HR = 2.5; p = 0.001) as well as in the primarily irradiated (HR = 1.7; p = 0.003) group.

Conclusions: We conclude from these results that elevated pre-therapeutic fibrinogen may serve as a biomarker associated with worsened prognosis in locally advanced head and neck cancer patients treated by either RT or surgery followed by adjuvant radiotherapy.

Background: In head and neck cancer, apart from the p16/HPV status and the infection with the Epstein–Barr virus (EBV), no clinically relevant biomarkers are currently known. Fibrinogen, a plasma protein, which is converted to fibrin by thrombin and thereby provides the basis for the generation of the clot, may be a biomarker candidate. In a variety of recent publications, the coagulation system and related processes have been postulated to play an important role in cancer via several possible mechanisms. In addition, numerous publications demonstrated that inflammation is linked to the coagulation system and inflammation-based scoring systems have been shown to be of prognostic value in cancer.

Edgar Selzer, Anja Grah, Gregor Heiduschka, Gabriela Kornek, Dietmar Thurnher, Wiener klinische Wochenschrift 9/10/2016

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